SFEEU2024 Society for Endocrinology Clinical Update 2024 Workshop H: Miscellaneous endocrine and metabolic disorders (19 abstracts)
Exploring metformin and GLP-1 analogues as therapeutic approaches for reactive hypoglycaemia in roux-en-y gastric bypass patients
Adwoa Nyarkoa Sefa 1 , Komal Rao 1 , Kavitha Lakshmipathy 1 , Younes R. Younes 1 , Benjamin C.T. Field 1,2 , Vidhu Nayyar 1 , James Clark 1 , Sunil Zachariah 1 & Julian Emmanuel 1
1East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, United Kingdom.; 2Section of Clinical Medicine, Faculty of Health & Medical Sciences, Guildford, United Kingdom
Background: Reactive hypoglycaemia following Roux-en-Y gastric bypass (RYGB) surgery poses unique challenges in diagnosis and management. This abstract explores the utility of Metformin and GLP-1 analogues in two distinct cases.
Case 1- LH: LH, a post-RYGB patient, presented with recurrent hypoglycaemic episodes, intriguingly manifesting primarily at night; after a long day at work in a fasted state followed by a carbohydrate heavy meal. LH experienced hypoglycaemic episode-related seizures, precipitating emergency department admissions. Mixed meal testing confirmed a significant drop in blood sugars (baseline 6.8 mmol/l, rising to 9 mmol/l and then dipping to 2.7 mmol/l, at 2 hours post-mixed meal), coupled with elevated insulin (2180 pmol/l from <10 pmol/l) and C-peptide levels (6625 pmol/l from 393 pmol/l), confirming reactive hypoglycaemia. Metformin, an off-label choice, successfully settled symptoms. Gradual dose escalation resulted in sustained improvement over three months, highlighting the potential for metformin in preventing post-prandial hypoglycaemia in this group of patients.
Case 2- LS: LS had a history of diabetes and Roux-en-Y gastric bypass, presented with sweats and light-headedness. Mixed meal test noted glucose fluctuation (baseline 5 mmol/l, peaking at 12.5 mmol/l in 30 minutes, then gradually dropping to 4.2-4.4 mmol/l, over the next two hours), suggestive of reactive hypoglycaemia. Metformin at 500 mg bd induced symptomatic relief, and modest weight loss. However, LS continued to experience late morning symptoms, prompting consideration of GLP-1 analogue therapy. The initiation and optimisation of GLP-1 did settle her symptoms. This case underlines the intricate balance between insulin excess and insulin resistance.
Conclusion: These cases illuminate potential roles for Metformin and GLP-1 analogue, in managing post-RYGB reactive hypoglycaemia. Tailoring interventions to the unique presentations of these patients underscores the need for personalised approach, in post-bariatric reactive hypoglycaemia management. Further research is warranted to establish the broader applicability and safety of these interventions, offering hope for enhanced patient outcomes in this challenging context.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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